unit c musculoskeletal_chpt__46 part ii voice and no underline

Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition

Linda S. Williams / Paula D. Hopper

Osteoporosis Bone Loses Density Bone cells are decalcified Fractures Occur



Osteoporosis Risk Factors Caucasian/Asian Postmenopausal Women Sedentary Lifestyle Decreased Calcium Intake Lack of Vitamin D Excessive Alcohol Use Cigarette Smoking



Osteoporosis Risk Factors Excessive Caffeine Intake Petite Body Build Postmenopausal women Inactive older adults



Osteoporosis Signs and Symptoms

◆Dowager’s Hump◆Kyphosis ◆Height Decreases ◆Back Pain ◆Fracture

http://www.google.com/imgres?imgurl=http://4.bp.blogspot.com/_



Osteoporosis Diagnostic Tests

Computed Tomography Ultrasound Serum Calcium, Vitamin D levels Serum Phosphorus DXA (Dual-energy x-ray absorptiometry) (Tool to measure bone density) (Widely used today)

Serum Alkaline Phosphatase (elevation confirms bone damage



Osteoporosis Therapeutic Interventions

Reduce Risk Factors Medication

◆Calcium Supplements◆Vitamin D◆Fosamax, Boniva, and Actonel are bisphosphonates, a

group of drugs that inhibit reabsorption of bone

◆Evista mimics estrogen in some parts of the body while blocking it in others

◆Forteo increases the number of osteocytes



Osteoporosis Nursing Care Education

◆Diet• Increase Calcium

◆Exercise◆Fall Prevention



Paget's Disease (osteitis deformans) Increased Bone Loss results in large

disorganized bone deposits throughout entire body

No Obvious Symptoms Usually, but pain is a major symptom in many patients.

X-ray, Bone Scan Calcitonin (calcimar) (thyroid hormone drug that is often

effective in initiating a remission)( Blood calcium regulator that shrinks osteoclasts)

Relieve Pain, Teach, Promote Life Quality



Bone Cancer Primary Malignant Tumors

◆Osteosarcoma or just sarcoma• Most Common• 50% Occur in Distal Femur in Young Men• Metastasizes to Lung Within 2 Years



Bone Cancer Primary Malignant Tumors

◆Ewing’s Sarcoma• Most Malignant

◆Chondrosarcoma• Cancer of Cartilaginous Cells• Better Prognosis



Primary Bone Cancer Therapeutic Interventions

◆Surgery, Chemotherapy, Radiation

Nursing Care◆Postoperative Care◆Supportive



Metastatic Bone Disease Bone-seeking Cancers

◆Prostate, Breast, Lung, Thyroid

Pathological Fractures Severe Pain Therapeutic Interventions

◆Radiation



Metastatic Bone Disease Nursing Care

◆Supportive care as with other Cancers



Gout Pathophysiology

◆Systemic Connective Tissue Disorder ◆Uric Acid Build up ◆Usually have hyperuricemia ◆Urate Crystals Deposited in Joints/connective

Tissues◆Severe Inflammation

Is classified as a metabolic disorder



Causes and Types Primary - Inherited Problem With Purine

Metabolism ◆Uric acid production is greater than the

kidneys’ ability to excrete it.

Secondary – Another Health Problem◆Secondary to renal insufficiency or medication

such as diuretic therapy or chemotherapy



Signs and Symptoms Acute

◆Swollen, Red, Hot, Painful Inflamed Joints ◆Great Toe

Chronic Gout◆Urate Deposits Under Skin ◆Renal Stones



Diagnostic Tests Serum Uric Acid Joint Fluid – Uric Acid Crystals

http://www.joshuakaye.com/images/gout.jpg



Therapeutic Interventions Medication

◆Colchicine (drug used to reduce the inflammatory response) may be given until pain subsides or nausea, vomiting, diarrhea, or intestinal cramping occur.

◆NSAIDS (nonsteroidal ant inflammatory drugs such as aspirin and ibuprofen) http://www.lyberty.com/encyc/articles/nsaid.html http://www.green-lipped-mussel-oil.com/nsaids.html

◆Allopurinol (Zyloprim) & Probenecid (Benemid)

• Uricosuric drugs (drugs that decrease uric acid)



Nursing Care Teaching

◆Diet – Avoid Foods High in Purines (end products of nucleoprotein digestion)

• Found in foods such as liver, organ meats, shellfish, and oily fish such as sardines

◆Avoid Aspirin, Diuretics, Alcohol • Alcohol especially beer may provoke an attack.

◆Increase Fluids to reduce the possibility of urate stone formation



Osteogenesis Imperfecta Congenital abnormality characterized by

skeletal bone fragility AKA Brittle Bones disease Pathological fractures Collagen synthesized abnormally by

fibroblasts and osteoblasts.



Osteogenesis Imperfecta Signs and Symptoms

◆Fragile bones ◆Triangular shaped face◆Potential hearing loss◆Scoliosis◆Loose joints

http://www.oif.org/site/PageServer (see page 1014 for list of symptoms)



Osteogenesis Imperfecta Signs and Symptoms Con’t

◆Alterations in muscle tone or development ◆Blue, purple, grey tint to sclera◆Brittle or discolored teeth◆Smooth, thin skin



Osteogenesis Imperfecta Diagnosis

◆History of fractures◆Physical◆Skin biopsy



Osteogenesis Imperfecta Therapeutic Interventions

◆No treatment◆Fracture care



Osteogenesis Imperfecta Nursing Care

◆Careful handling ◆Teaching (patient and caregivers may feel

guilty when fracture occurs)◆Support groups

• Osteogensis Imperfecta Foundation



Polymyositis Diffuse Inflammation of Skeletal Muscle

which lead to weakness, atrophy and degeneration

Dermatomyositis – polymyositis with rash Progressive Remissions and Exacerbations Women > Men Treatment: Prednisone



Polymyositis Nursing Care

◆Supportive Care◆Education



Muscular Dystrophy Group of 9 Disorders Loss of Muscle Tissue Progressive Muscle Weakness Genetic Skeletal muscle fibers degenerate, atrophy



Therapeutic Interventions Supportive Care Prevention of Complications Gene Therapy Research

◆ http://www.youtube.com/watch?v=vfeAJxtb-F8



Nursing Diagnoses Impaired Physical Mobility Ineffective Breathing Pattern Self Care Deficits Deficient Knowledge



Osteoarthritis Degenerative Joint Disease (DJD) Common Slow progressive degeneration of joint

articular cartilage http://video.about.com/arthritis/Arthritis.htm



Pathophysiology Articular Cartilage/Joints Bone Ends

Deteriorate Joint Space Narrows, Bone Spurs Develop,

Joint Inflamed Joint Deformities, Pain, Immobility Weight-bearing Joints



Joints Affected By Osteoarthritis



Causes Unknown Risk Factors

◆Aging◆Obesity◆Excessive “Wear and Tear” on Synovial Joints



Signs and Symptoms Joint Pain

◆Intensifies After Physical Activity

Stiffness Heberden’s and Bouchard’s Nodes

◆Bony Nodes on Joints of Fingers

http://www.healthinplainenglish.com/health/musculoskeletal/osteoarthritis/heberden-nodes.jpg



Diagnostic Tests X-rays CT MRI Synovial Fluid Analysis



Therapeutic Interventions No Cure Medication

◆NSAIDS

Rest and Exercise Heat or Cold Weight Control http://www.webmd.com/video/injectable-gel-osteoarthritis



Therapeutic Interventions Complementary Therapies

◆Imagery, Music Therapy, Acupressure, Acupuncture

Surgery◆Total Joint Replacement



Nursing Diagnoses Chronic Pain Activity Intolerance Chronic Sorrow Disturbed Body Image Impaired Physical Mobility Self-care Deficit Ineffective Health Maintenance



Patient Education Protect Joints Conserve Energy The patient with prolonged osteoporosis

may experience fractures

unit c musculoskeletal_chpt__46 part ii voice and no underline

Health & Medicine

medical surgical nursing

williams paula

edition linda

hopperosteoporosis bone

hopper signs

bone density

density bone cells

pain fracture http